Provider Demographics
NPI:1053114322
Name:CREEK, JACKSON
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:CREEK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15800 SUMMIT PLZ
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1970
Mailing Address - Country:US
Mailing Address - Phone:531-299-3040
Mailing Address - Fax:
Practice Address - Street 1:15800 SUMMIT PLZ
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1970
Practice Address - Country:US
Practice Address - Phone:531-299-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant